LAD-NASH score using multiparametric ultrasound for identification of at-risk MASH: head-to-head comparison with the FAST score.

PURPOSE: Noninvasive scores have been proposed to identify patients with at-risk metabolic dysfunction-associated steatohepatitis (MASH) who may benefit from pharmacologic therapy. The LAD-NASH (model combining attenuation coefficient, dispersion slope, and liver stiffness for identification of nonalcoholic steatohepatitis) score, a multiparametric ultrasound (US)-based model that combines the attenuation coefficient, dispersion slope, and liver stiffness to identify nonalcoholic steatohepatitis, was recently developed for this purpose. This study aimed to validate the LAD-NASH score for identifying at-risk MASH in patients with biopsy-proven metabolic dysfunction-associated steatotic liver disease (MASLD) and to compare its diagnostic performance with that of the FibroScan-aspartate aminotransferase (FAST) score. METHODS: This study enrolled consecutive patients who underwent multiparametric US and liver biopsy on the same day between February 2023 and April 2024. At-risk MASH was defined as biopsy-confirmed MASH with a MASLD activity score of ≥4 and fibrosis stage of ≥F2. The diagnostic performance of the LAD-NASH and FAST scores was evaluated using the areas under the receiver-operating characteristic curves (AUROCs). RESULTS: A total of 70 patients with biopsy-proven MASLD were included (median age, 44 years; 34 men; median body mass index, 28.7 kg/m²; at-risk MASH, 27.1%). The LAD-NASH and FAST scores demonstrated comparable diagnostic performance for identifying at-risk MASH (AUROCs, 0.740; 95% confidence intervals [CI], 0.621 to 0.838 vs. 0.739; 95% CI, 0.621 to 0.837; P=0.995). Using the rule-out cutoff of ≤0.264, the LAD-NASH score demonstrated 100% sensitivity and 100% negative predictive value for at-risk MASH. CONCLUSION: The LAD-NASH and FAST scores showed comparable diagnostic performance for identifying at-risk MASH. Because it is based solely on multiparametric US, the LAD-NASH score may be a useful noninvasive rule-out tool for at-risk MASH.